Coronary Artery Disease
Comparison of Epicardial Adipose Tissue Volume and Coronary Artery Disease Severity in Asymptomatic Adults With Versus Without Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2014.05.057Get rights and content

Epicardial adipose tissue (EAT) has been shown to have important effects on the development of coronary artery disease (CAD) through local paracrine influences on the vascular bed. We compared a cohort of asymptomatic patients with type II diabetes mellitus (DM) without known CAD to an age- and gender-matched group of asymptomatic patients without DM from the CTRAD (Cardiac CT's Role in Asymptomatic Patients with DM-II) study in which patients underwent a cardiac computed tomography angiogram, for early detection of CAD. Mean EAT volumes of 118.6 ± 43.0 and 70.0 ± 44.0 cm3 were found in the DM and non-DM groups, respectively. When stratified by the presence and severity of CAD, it was found that in the DM (p = 0.003) and non-DM groups (p <0.001), there was a statistically significant increase in EAT volume as the patients were found to have increasingly severe CAD. After adjusting for age, race, gender, DM, hypertension, insulin use, body mass index, and coronary artery calcium (CAC) score, the presence of >120 cm3 of EAT was found to be highly correlated with the presence of significant CAD (adjusted odds ratio 4.47, 95% confidence interval 1.35 to 14.82). We found that not only is EAT volume an independent predictor of CAD but that an increasing volume of EAT predicted increasing severity of CAD even after adjustment for CAC score.

Section snippets

Methods

Coronary computed tomography angiograms (CTAs) were used from the CTRAD study (Cardiac CT's Role in Asymptomatic Patients with DM-II) in which consecutive asymptomatic patients (n = 203) with type II DM from 3 community clinics of the University of California, Irvine, were randomly assigned to either undergo 64-slice computed tomography (CT) angiography or continue their usual care. Type II DM was defined as a fasting blood glucose of ≥126 mg/dl, a physician-documented diagnosis of DM, current

Results

Table 1 describes the clinical characteristics of the 362 study patients, of which 92 (25.4%) were patients with DM who had no symptoms of CAD and 270 asymptomatic patients without DM (non-DM). The mean age in the DM group and non-DM group were 56.2 ± 9.5 and 57.2 ± 9.7 years, respectively. In the DM group, 57.9% of the patients were women as were 60% of the patients in the non-DM group. The mean BMI for participants with DM and without DM was statistically significantly different (p <0.0001).

Discussion

CAD and its complications continue to be the leading cause of the death in the United States and in many countries abroad.13 With the obesity epidemic, consequent insulin resistance, and the increased prevalence of type II DM, death from CAD will remain high for the foreseeable future. Traditional markers of obesity including BMI rely on the global burden of body obesity, including less metabolically active subcutaneous generalized depots of adipose. There is a nonlinear association of BMI and

Disclosures

The authors have no conflicts of interest to disclose.

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    We received grant funding from National Heart, Lung, Blood Institute (KHL097158A to S. Malik).

    See page 690 for disclosure information.

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